Japanese Journal of Infectious Diseases
Online ISSN : 1884-2836
Print ISSN : 1344-6304
ISSN-L : 1344-6304
Volume 66, Issue 2
Displaying 1-17 of 17 articles from this issue
Invited Review
  • Kazue Nakanaga, Rie Roselyne Yotsu, Yoshihiko Hoshino, Koichi Suzuki, ...
    Article type: Invited Review
    2013 Volume 66 Issue 2 Pages 83-88
    Published: 2013
    Released on J-STAGE: March 21, 2013
    JOURNAL FREE ACCESS
    Buruli ulcer (BU) is an emerging human disease caused by Mycobacterium ulcerans, which mainly affects the extremities. It is most endemic in sub-Saharan Africa; however, it has been reported worldwide, including in some non-tropical areas. “M. ulcerans subsp. shinshuense” is proposed as a subspecies of M. ulcerans, which have been reported from Japan and China. A total of 35 BU cases have been reported as of November 2012. Although M. ulcerans is categorized as nontuberculous mycobacteria, it has some unique characteristics that could only be observed in this bacterium. It possesses a giant virulent plasmid, composed of 174-kbp nucleotides, coding polyketide synthase to produce macrolide toxin called mycolactone. The discovery of such a linkage of plasmid and its pathogenesis has not been reported in other human disease-causing mycobacteria.
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Original Article
  • Wei-Chang Huang, Chao-Hsien Chen, Chen-Cheng Huang, Kun-Ming Wu, Chien ...
    Article type: Original Article
    2013 Volume 66 Issue 2 Pages 89-95
    Published: 2013
    Released on J-STAGE: March 21, 2013
    JOURNAL FREE ACCESS
    The aim of this study was to determine the performance of the national “STOP TB” program in central Taiwan during 2003–2007 by examining trends in the combined drug resistance to first-line anti-tuberculosis (TB) drugs among clinical Mycobacterium tuberculosis isolates. Using 4,819 clinical M. tuberculosis isolates obtained from two mycobacteriology referral laboratories, the resistance to drugs was measured and analyzed along with the treatment outcomes in notified TB patients. The proportion of isolates showing total resistance and multidrug-resistant tuberculosis (MDR-TB) isolates were 17.7% and 3.67%, respectively. More number of MDR-TB isolates showed high-level resistance to isoniazid (84.18%) and streptomycin (SM) (30.51%); low-level resistance to ethambutol (EMB) (61.58%), SM (41.81%), and pyrazinamide (66.1%); and resistance to ofloxacin (30.4%). However, fewer isolates showed high-level resistance to EMB (19.77%), levofloxacin (17.9%), moxifloxacin (19.6%), kanamycin (8.9%), amikacin (8.9%), and capreomycin (8.9%). Of these MDR-TB isolates, 7.1% were extensively drug-resistant. Trends in combined drug resistance to all the first-line anti-TB drugs and the incidence of MDR-TB were stable during the 2 years (2003–2004) before the implementation of the national “STOP TB” program. After the “STOP TB” program, there were significant declines in the incidence of MDR-TB during 2005–2007 in central Taiwan as well as improved TB-treatment outcomes. Thus, the national “STOP TB” program had a significant positive impact on TB control in central Taiwan.
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  • Tieli Zhou, Xiaolei Zhang, Meiyan Guo, Jianbo Ye, Yamin Lu, Qiyu Bao, ...
    Article type: Original Article
    2013 Volume 66 Issue 2 Pages 96-102
    Published: 2013
    Released on J-STAGE: March 21, 2013
    JOURNAL FREE ACCESS
    Carbapenem resistance in Enterobacteriaceae is increasing and has become a matter of great concern. The aim of this study was to characterize carbapenem-non-susceptible Enterobacteriaceae from a teaching hospital. A total of 49 carbapenem-non-susceptible Enterobacteriaceae clinical isolates recovered in 2007–2010 from the First Affiliated Hospital of Wenzhou Medical College were analyzed by antimicrobial susceptibility testing. The carbapenemase phenotype, outer membrane protein profiles, and clonal relatedness were investigated using the modified Hodge test, sodium dodecyl sulfate-polyacrylamide gel electrophoresis, and pulsed-field gel electrophoresis (PFGE). Multilocus sequence typing (MLST) of Klebsiella pneumoniae was also performed. β-Lactamase genes were examined by PCR and sequencing, and the transferability of carbapenemase genes was determined by a conjugation experiment. The rates of imipenem, meropenem, and ertapenem resistance were 59.2%, 40.8%, and 96.0%, respectively. Thirty isolates exhibited carbapenemase activity, and 32 isolates carried carbapenemase genes. Furthermore, 10 and 9 clinical isolates posessed AmpC β-lactamase and extended-spectrum β-lactamase (ESBL) genes, respectively. Eight of 32 carbapenemase-producing isolates were proved to be carried by conjugative plasmids, and there was porin loss in 34.7% (17/49) of the isolates. PFGE analysis demonstrated that 9 KPC-2-producing Serratia marcescens belonged to a clonal strain, suggesting the clonal dissemination of these KPC-2-bearing isolates among different wards. The MLST of K. pneumoniae revealed that two KPC-2 producers were ST11. This study suggests that KPC-2-type carbapenemase is the main contributor to carbapenems resistance in carbapenemase-producing Enterobacteriaceae, and that ESBL, AmpC β-lactamase overproduction, and porin loss contribute to the resistance level among these isolates; in carbapenemase-non-producing Enterobacteriaceae, ESBL, AmpC enzyme, and porin loss contribute to the carbapenems resistance of Enterobacteriaceae, especially the ertapenem resistance of Enterobacter cloacae.
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  • Keiko Yamada, Jin Wanchun, Teruko Ohkura, Atsushi Murai, Reina Hayakaw ...
    Article type: Original Article
    2013 Volume 66 Issue 2 Pages 103-108
    Published: 2013
    Released on J-STAGE: March 21, 2013
    JOURNAL FREE ACCESS
    Immunodetection of methicillin-resistant Staphylococcus aureus (MRSA) by conventional methods employing mammalian immunoglobulins has unknown detection limits, and often yields false-positive results because of the presence of S. aureus protein A, which binds the Fc region of mammalian IgG. In this study, a new PBP2a-specific chicken IgY antibody was developed in inbred and conventional chickens, and used for the detection of MRSA using whole cell lysate samples. Our results showed that this chicken IgY antibody minimized the side effects of protein A. Moreover, enzyme-linked immunosorbent assay and immunochromatography systems were used with a monoclonal and polyclonal anti-PBP2a IgY antibody, clearly differentiating MRSA from methicillin-sensitive S. aureus and other methicillin-sensitive Staphylococcus spp. The detection limit of the immunochromatography was 108 colony-forming units; therefore, 1 colony on an agar plate was adequate to distinguish MRSA from non-MRSA. The specificity and sensitivity of this assay were almost similar to that of a commercially available latex agglutination test; however, the procedure used in this study was less complicated. The entire detection procedure, including sample preparation, takes only 20 min and does not require special equipment. Therefore, the use of this IgY antibody as a new tool for the detection of MRSA is highly recommended.
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  • Toyokazu Yukawa, Toshifumi Ohkusa, Tomoyoshi Shibuya, Shintaro Tsukina ...
    Article type: Original Article
    2013 Volume 66 Issue 2 Pages 109-114
    Published: 2013
    Released on J-STAGE: March 21, 2013
    JOURNAL FREE ACCESS
    Fusobacterium varium is an elusive pathogenic factor in ulcerative colitis (UC); conventional methods of fecal culture rarely recover F. varium. We have developed a nested culture method to recover Fusobacterium and we used it to investigate whether F. varium could be isolated from UC patients. We enrolled 50 consecutive patients in this study; 26 received combination antibiotic therapy that included amoxicillin, tetracycline, and metronidazole (ATM) for 2 weeks and were thus assigned to the ATM group, and the remaining 24 were assigned to the non-ATM group and did not receive any antibiotics. Stool samples were added to 10 ml of GAM broth that contained neomycin and crystal violet. The samples were vortexed and incubated under anaerobic conditions. The preincubated broth was streaked onto a Fusobacterium-selective agar plate and then incubated under anaerobic conditions. The species of the colonies isolated were identified using the Vitek Automated system and PCR analysis. We recoverd F. varium from 7 of the 24 non-ATM patients (29.2%) and none from the ATM patients (0%) (P = 0.0035). All of the F. varium isolates were susceptible to ATM. This study suggests that the recovery of F. varium is related to UC, which aligns with results from previous studies that used mucosal culture, immunostaining, real-time PCR, and serological studies.
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  • Aylin Babalik, Zeki Kilicaslan, S. Sevkan Caner, Gokay Gungor, M. Gone ...
    Article type: Original Article
    2013 Volume 66 Issue 2 Pages 115-120
    Published: 2013
    Released on J-STAGE: March 21, 2013
    JOURNAL FREE ACCESS
    The aim of this study is to evaluate the treatment outcomes and identify factors associated with adverse tuberculosis treatment outcomes for bacteriologically confirmed pulmonary tuberculosis. Treatment outcomes of pulmonary tuberculosis were evaluated retrospectively among 11,186 smear- and/or culture-positive patients treated between 2006 and 2009 in Istanbul, Turkey. Adverse treatment outcomes were identified in 1,010 (9.0%) patients including death (1.8%), treatment default (6.1%), and treatment failure (1.1%). Factors associated with adverse treatment outcomes included being born abroad (odds ratios [OR], 5.38; 95% confidence intervals [CI], 3.67–7.91), history of tuberculosis treatment (OR, 3.77; 95% CI, 3.26–4.36), age > 65 years (OR, 2.79; 95% CI, 2.21–3.53), and male gender (OR, 1.91; 95% CI, 1.59–2.27). Death was most strongly associated with age > 65 years (OR, 45.1; 95% CI, 27.0–75.6), followed by treatment default with history of interrupted treatment (OR, 11.6; 95% CI, 8.94–15.1), and treatment failure with prior history of treatment failure (OR, 17.1; 95% CI, 6.97–41.6). Multidrug resistance was strongly associated with adverse treatment outcomes (OR, 10.8; 95% CI, 8.02–14.6). Age > 65 years, male sex, being born abroad, and history of treatment failure were found to be risk factors for adverse treatment outcomes. Hence, patients with any of these characteristics should be carefully monitored and treated aggressively.
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  • Romanee Chaiwarith, Teewin Ngamsrikam, Sawalak Fupinwong, Thira Sirisa ...
    Article type: Original Article
    2013 Volume 66 Issue 2 Pages 121-125
    Published: 2013
    Released on J-STAGE: March 21, 2013
    JOURNAL FREE ACCESS
    This retrospective study was conducted among healthcare workers (HCWs) in a tertiary care hospital to (i) determine the incidence of exposure to blood and/or body fluids, (ii) describe the characteristics of such exposures, and (iii) describe management after exposure. There were 1,611 episodes of occupational exposure between January 1, 2005 and December 31, 2010. Of those affected, 1,086 (67.4%) were women. The mean age was 27.6 ± 7.2 years. Nurses (483, 29.9%) were the HCWs most frequently exposed to blood and/or body fluids. The incidence was highest among physicians (11%/year). Percutaneous injury by hollow needles was the most common type of injury (576, 35.8%). Of the 1,611 episodes, 142 (8.8%) comprised HCWs being exposed to human immunodeficiency virus-positive sources. One hundred fifty-one HCWs (9.4%) were exposed to hepatitis B surface (HBs) antigen-positive sources. Sixty-one HCWs had indications for both hepatitis B virus (HBV) vaccine and hepatitis B immunoglobulin; 43 (70.5%) received both. Among the 266 HCWs who had no protective antibody against HBV and were exposed to HBs antigen-negative sources, only 1 (0.4%) received HBV vaccine. These findings suggest that guidelines for post-exposure management among HCWs exposed to HBs antigen-positive sources are not regularly followed. HBV immunization is necessary for all HCWs.
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  • Kenta Takahashi, Yasuko Orba, Taichi Kimura, Lei Wang, Shinji Kohsaka, ...
    Article type: Original Article
    2013 Volume 66 Issue 2 Pages 126-132
    Published: 2013
    Released on J-STAGE: March 21, 2013
    JOURNAL FREE ACCESS
    JC virus (JCV) is a causative agent of progressive multifocal leukoencephalopathy (PML). Methyl CpG binding protein 2 (MeCP2) is a transcriptional control nuclear protein that is abundantly expressed in neurons. We previously observed that the MeCP2 protein is expressed in JCV large T antigen (TAg)-expressing glial cells in PML brains. To investigate the relationship between MeCP2 and JCV TAg, we examined the promoter activity and mRNA and protein expression levels of MeCP2 in JCV TAg-expressing cells. We found that JCV TAg enhances the promoter activity of MeCP2, but does not enhance the mRNA and protein levels of MeCP2. These results suggest that post-transcriptional mechanisms may play a role in MeCP2 expression.
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  • Daisuke Sasai, Yoichiro Okubo, Takao Ishiwatari, Takashi Sugita, Takeh ...
    Article type: Original Article
    2013 Volume 66 Issue 2 Pages 133-139
    Published: 2013
    Released on J-STAGE: March 21, 2013
    JOURNAL FREE ACCESS
    The efficacy of polyene macrolides to treat experimental Trichosporon bloodstream infection was evaluated by histopathological examination and viable cell counts in the kidneys of infected mice. Viable cell counts on the 5th day after infection confirmed that liposomal amphotericin B (L-AMB) is a more effective treatment than fluconazole (FLC) for mice infected with an azole-resistant strain of Trichosporon. Histological examination revealed that the administration of L-AMB induced a transformation from acute purulent inflammation caused by both azole-susceptible and -resistant strain infections to a chronic and subsiding form, whereas FLC failed to convert the acute inflammation induced by the azole-resistant strain to a subsiding form. Our results demonstrate that polyene macrolides can be used as an alternative therapy for infection of azole-resistant strains of Trichosporon and that histopathological evaluation is useful for elucidating the pathophysiology of an experimental Trichosporon infection.
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  • Katsumi Mizuta, Chieko Abiko, Yoko Aoki, Tatsuya Ikeda, Yoko Matsuzaki ...
    Article type: Original Article
    2013 Volume 66 Issue 2 Pages 140-145
    Published: 2013
    Released on J-STAGE: March 21, 2013
    JOURNAL FREE ACCESS
    Most acute respiratory infections (ARIs) are thought to be associated with respiratory viruses that cause similar symptoms. Therefore, assessment of clinical and epidemiologic features of these viruses is important for diagnosing a viral infection. We collected 13,325 nasopharyngeal specimens from patients with ARIs and isolated the virus using a microplate method involving 7 cell lines between 2004 and 2011 in Yamagata, Japan. We isolated a total of 5,483 viruses. Respiratory syncytial virus (RSV), influenza A virus (FluA), human metapneumovirus (hMPV), and human parainfluenza virus type 3 (hPIV3) showed clear yearly seasonal patterns; generally, RSV infections peaked at the end of the year, FluA infections peaked between January and March, hMPV infections peaked between March and April, and hPIV3 showed seasonal outbreaks between May and July. Further, RSV, hMPV, and hPIV3 were commonly isolated in 12.0–13.1% of specimens from children aged less than 4 years, whereas FluA was isolated in 7.3–8.2% of specimens from school-aged children. A generalized view of seasonality and age distribution, particularly on the basis of longitudinal epidemiological data, will be helpful for medical decision-making, including decisions related to the use of rapid test kits, selection of antiviral treatments, restriction of antibiotic therapy, and implementation of infection control strategies.
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Short Communication
  • Bayrı Eraç, Mine Hoşgör-Limoncu, Şafak E ...
    Article type: Short Communication
    2013 Volume 66 Issue 2 Pages 146-148
    Published: 2013
    Released on J-STAGE: March 21, 2013
    JOURNAL FREE ACCESS
    In this study, we examined the prevalence of the PER-1 enzyme and the presence of clinically important integron classes in ceftazidime-resistant Gram-negative bacteria isolated at a university hospital. The blaPER-1 gene was detected by PCR in 33 (19.5%) of the total 169 Gram-negative bacteria, including 17 (23.3%) of the 73 Pseudomonas aeruginosa isolates and 16 (25%) of the 64 Acinetobacter baumannii complex isolates. Molecular fingerprinting revealed that blaPER-1 prevalence was mostly due to the dissemination of clonally related P. aeruginosa and A. baumannii complex strains. Class 1 integron (intI1) was detected in 52.7% of the 169 bacteria examined in this study. Its detection rates were estimated at 49.3% and 57.8% of the P. aeruginosa and A. baumannii complex strains isolated, respectively. It was also detected in 11 of the 16 Escherichia coli isolates and 5 of the 10 Klebsiella pneumoniae isolates. A single E. coli isolate and another K. pneumoniae isolate contained both class 1 and class 2 integrase genes. The results of this study revealed that clonally related blaPER-1-positive P. aeruginosa and A. baumannii complex strains, mostly harboring intI1, had disseminated at our hospital.
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  • Xianfeng Zhou, Guoyin Fan, Wen Xia, Fenglan He, Maohong Hu, Xiansheng ...
    Article type: Short Communication
    2013 Volume 66 Issue 2 Pages 149-150
    Published: 2013
    Released on J-STAGE: March 21, 2013
    JOURNAL FREE ACCESS
    Hand, foot, and mouth disease (HFMD) is caused by enteroviruses, most commonly enterovirus 71 (EV71) and coxsackievirus A16 (CA16). In general, EV71 infection is more likely to induce severe complications and mortality than other enterovirus infections. The present study focuses on the molecular epidemiology of human EV71 strains in the Nanchang region of China in 2011. Overall, 651 specimens (throat or rectal swabs) were collected, and one-step reverse transcriptase-polymerase chain reaction was performed for analysis. Enteroviruses were detected in 62.2% (405/651) of the specimens. EV71, CA16, and other enteroviruses were found in 292, 73, and 40 specimens, respectively. Phylogenetic analysis of the VP1 region of the 8 EV71 strains found in the Nanchang region indicated that these strains belong to the C4 subgenotype. This study shows that the C4 subgenotype strain of EV71 was prevalent in the HFMD cases of Nanchang in 2011, and it reports the first incidence of adults being infected by EV71 in the Nanchang region. Thus, the surveillance of HFMD epidemiology and monitoring of HFMD severity should be continued.
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  • Nam Hee Kim, Eun Hwa Choi, Ji Yeon Sung, Chi Eun Oh, Hong Bin Kim, Eui ...
    Article type: Short Communication
    2013 Volume 66 Issue 2 Pages 151-154
    Published: 2013
    Released on J-STAGE: March 21, 2013
    JOURNAL FREE ACCESS
    A total of 279 isolates of Escherichia coli (n = 128) and Klebsiella pneumoniae (n = 151) were obtained from blood samples from children at the Seoul National University Children's Hospital, Seoul, Korea from 1999 to 2007. Five plasmid-mediated quinolone resistance (PMQR) genes, qnrA, qnrB, qnrS, qepA, and aac(6′)-Ib-cr, and the minimal inhibitory concentration (MIC) values for ciprofloxacin were tested for all the strains. Mutations in both gyrA and parC were analyzed in 57 representative strains. Twenty-seven strains (9.7%) had at least 1 of the 5 PMQR genes: qnrB in 20 isolates, qnrS in 1, aac(6′)-Ib-cr in 5, and both qnrB and aac(6′)-Ib-cr in 1 isolate. The overall PMQR prevalence rates tended to increase over time (P = 0.001). The non-susceptibility rate to ciprofloxacin was 11.0% (31/279). PMQR-harboring isolates tended to have increased ciprofloxacin MIC values among both quinolone resistance-determining region (QRDR) mutation-present (P = 0.016) and QRDR mutation-absent isolates (P < 0.001). The increasing prevalence of PMQR genes was associated with increase in quinolone use over time (P < 0.001) and increasing frequency of non-susceptibility to ciprofloxacin (P < 0.001).
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  • Jae-Hoon Lee, Ju-Hyung Lee, Kyung Min Chung, Eu Suk Kim, Yee Gyung Kwa ...
    Article type: Short Communication
    2013 Volume 66 Issue 2 Pages 155-157
    Published: 2013
    Released on J-STAGE: March 21, 2013
    JOURNAL FREE ACCESS
    The clinical manifestations and complications of scrub typhus are variable. Few studies have examined the timeline of clinical symptoms after the appropriate antimicrobial agents have been administered. The most prevalent clinical manifestations are fever and cough, followed by headache, myalgia, eschar, skin rash, and nausea. Systemic symptoms are most severe during the early stages of illness (i.e., the first 5 days), but resolve slowly within 2 weeks. The associated skin rash is most severe during the first 8 days of infection, but it resolves slowly within 21 days.
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  • Kouji Kimura, Kousaku Matsubara, Go Yamamoto, Keigo Shibayama, Yoshich ...
    Article type: Short Communication
    2013 Volume 66 Issue 2 Pages 158-160
    Published: 2013
    Released on J-STAGE: March 21, 2013
    JOURNAL FREE ACCESS
    Group B streptococcus (GBS; Streptococcus agalactiae) is a leading cause of neonatal invasive infections and was believed to be fully susceptible to penicillin. However, we recently identified several clinical GBS isolates with reduced penicillin susceptibility (PRGBS), which were mainly isolated from respiratory specimens of elderly people. An investigation of both the isolation rate of PRGBS and the serotype distribution among pregnant women is crucial to decisions regarding optimal prevention and strategies for GBS treatment in neonates. We collected 141 GBS isolates from vaginal specimens of 122 pregnant women in a hospital in Kobe, Japan, from 2007 to 2008. Of the 141 GBS isolates, 139 were subjected to antimicrobial susceptibility testing based on the results of screening for PRGBS by the disk diffusion method. All 139 isolates were susceptible to penicillin G, ampicillin, cefotaxime, cefepime, and meropenem; no PRGBS isolates were detected. However, the rates of erythromycin and clindamycin resistance in the isolates were 10.1% and 5.0%, respectively, which are much higher than the values previously reported in Japan. Serotypes VI and VIII accounted for 26% of GBS; a markedly decreased percentage from the rates observed around the year 2000. These findings suggested that penicillin remains an effective means of intrapartum antibiotic prophylaxis in Japan.
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  • Yoshimasa Sasaki, Mika Haruna, Mariko Murakami, Mizuho Hayashida, Kazu ...
    Article type: Short Communication
    2013 Volume 66 Issue 2 Pages 161-164
    Published: 2013
    Released on J-STAGE: March 21, 2013
    JOURNAL FREE ACCESS
    We investigated the prevalence of Campylobacter spp., Salmonella spp., Listeria monocytogenes, and hepatitis E virus (HEV) in swine liver. We collected swine livers from 110 pigs at an abattoir from September 2010 to March 2011. Pathogens were detected in the liver samples of 19 (17.3%) pigs. Campylobacter spp. were isolated from the liver samples of 14 (12.7%) pigs. In 10 of the 14 Campylobacter-positive pigs, bacteria were present in the internal regions of the liver. Salmonella spp. and L. monocytogenes were detected in the liver samples of 5 (4.5%) pigs and 1 (1%) pig, respectively. No HEV was detected in the swine liver samples tested. Regarding antimicrobial resistance in Campylobacter and Salmonella isolates, all isolates, except 1 Campylobacter jejuni isolate, were resistant to 1 or more antimicrobial agent. Campylobacter spp. resistant to erythromycin and/or enrofloxacin were isolated from the liver samples of 9 (8%) pigs. These results suggest that the consuming swine liver without proper heat treatment may increase the risk of foodborne illnesses.
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Laboratory and Epidemiology Communications
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